peds

Question 1

rapidly progressive gynecomastia, this patient has a low to normal testosterone level, elevated estradiol, and a striking rise in β-hCG, which most commonly represents a ??

workup???

Answer 1

hCG-secreting germ cell tumor of the testis

**testicular ultrasound

Question 2

in GALT deficiency, because excessive galactose can impair leukocyte function and superoxide release, patients are also at increased risk for ??? sepsis, which may be the initial presentation of galactosemia in some neonates.

Answer 2

Escherichia coli

Question 3

galactosemia, an inborn error of metabolism caused by a deficiency of the enzyme galactose 1-phosphate uridylyltransferase (GALT) can cause what eye finding???

GALT is responsible for the metabolization of galactose, found in breast milk and cow’s milk–based formula, into glucose

Answer 3

bilateral cataracts

Question 4

congenital adrenal hyperplasia (CAH) caused by 21-hydroxylase deficiency results in decreased what??

Answer 4

decreased mineralocorticoids, glucocorticoids

increased androgens

Question 5

Widened wrists, radial/ulnar bowing and delayed fontanel closure in a young infant is caused by?

Answer 5

nutritional vitamin D deficiency

Question 6

isolated pubic and axillary hair in a young girl

also body odor, oily skin, acne

Answer 6

Isolated premature adrenarche caused by early activation of adrenal androgens. Mildly elevated dehydroepiandrosterone sulfate present in children with premature adrenarche is not sufficient to affect skeletal growth; therefore, bone age is normal in these patients

Question 7

During DKA, serum glucose exceeds the threshold for reabsorption by the kidneys, resulting in glucosuria and an osmotic diuresis. This diuresis causes what change in potassium

Answer 7

depletion of total body potassium stores

serum potassium levels may be normal (as seen in this patient) or elevated because acidemia and decreased insulin activity cause a potassium shift to the extracellular fluid compartment.

Question 8

breast development, advanced bone age, and elevated basal LH levels in a female suggest ???

Answer 8

Central (gonadotropin-dependent) precocious puberty (PP)

Question 9

Patients with central (gonadotropin-dependent) precocious puberty (PP) (increased basal LH, increased bone age, breast development) require which workup

Answer 9

MRI of the brain to evaluate for hypothalamic or pituitary tumor.

Once a CNS tumor is excluded, the primary treatment for idiopathic central PP is GnRH agonist therapy

Question 10

child with marfanoid habitus (eg, long arms and fingers), and mucosal neuromas (eg, painless, rubbery tongue nodules) likely has type

Answer 10

2B multiple endocrine neoplasia (MEN2B).

Question 11

MEN2B and 2A are at greatest risk for developing?

Answer 11

medullary thyroid cancer (MTC)

produces calcitonin

Question 12

patient’s early onset of secondary sexual characteristics, advanced bone age, and low LH level are suggestive of peripheral precocious puberty, likely ???

Answer 12

nonclassic congenital adrenal hyperplasia (CAH)

Question 13

Temperature instability (eg, fever, hypothermia), CNS signs (eg, lethargy, irritability, apnea), Poor feeding, Respiratory distress (eg, tachypnea, grunting), Jaundice

all signs of ?

Answer 13

neonatal sepsis

Question 14

3 pathogens responsible for neonatal sepsis

Answer 14

Group B Streptococcus

Escherichia coli

Listeria monocytogenes (age <7 days

Question 15

if neonatal sepsis is suspected what is next step?

Answer 15

complete blood count with differential, urinalysis, cerebrospinal fluid (CSF) analysis, and cultures of all 3 fluids (blood, urine, CSF)

Question 16

After cultures are obtained for sepsis, neonates should immediately receive empiric antibiotics; which ones?

Answer 16

ampicillin and gentamicin

Question 17

hildren with pharyngitis and no viral symptoms (eg, rhinorrhea, cough) should undergo group A Streptococcus (GAS) rapid antigen detection testing. Due to the risk of acute rheumatic fever with untreated GAS, a ???? is performed to confirm a negative result.

Answer 17

throat culture

Question 18

???? , small white lesions found on the buccal mucosa opposite the molars, do not appear in all patients but are pathognomonic of measles and may last several days

Answer 18

Koplik spots

Question 19

A blanching, fine, pink maculopapular rash erupts on the face and spreads cephalocaudally within 24 hours, sparing the palms and soles + arthralgia and/or arthritis at the time of rash development

Answer 19

rubella

Question 20

work-up for suspected children’s infective endocarditis

(prolonged fever + new murmur, especially in pts with congenital defects)

Answer 20

blood cultures and echo

Question 21

acute, unilateral cervical lymphadenitis is an infection that typically occurs in children age <5. Patients typically have an enlarged (3-6 cm) cervical node that is markedly tender, warm, and erythematous.

Empiric antibiotic therapy is typically with ????, which has activity against S pyogenes, methicillin-resistant S aureus (MRSA), and anaerobes

Answer 21

clindamycin

Question 22

patient with pneumonia that has not improved despite appropriate antibiotics, as well as a new loculated pleural effusion on imaging, likely has an ???

Answer 22

empyema

Question 23

in children, the most common pathogens that cause empyema are Streptococcus pneumoniae and Staphylococcus aureus, including methicillin-resistantStaphylococcus aureus (MRSA). Therefore, in ill-appearing patients who require hospitalization, empiric antibiotic therapy should include ???

Answer 23

ceftriaxone or cefotaxime plus MRSA coverage with vancomycin or clindamycin

Question 24

Modifiable risk factors for acute otitis media (strep pneumo, h flu, moraxella) include lack of breastfeeding, day care attendance, and ??

Answer 24

cigarette smoke exposure

Question 25

Empiric antibiotics are not recommended for bloody diarrhea in children because they increase the risk for ??? if the causative pathogen is high-risk STEC (ie, E coli O157:H7)

well-appearing children with acute diarrhea are managed with supportive care (eg, oral rehydration) and close follow-up only

Answer 25

hemolytic uremic syndrome (HUS)

Question 26

lifelong immunity is not conferred from vaccination or prior ???? infection. Acquired immunity wanes 5-10 years postvaccination, allowing fully immunized patients to be susceptible to infection

Patients develop a paroxysmal cough in which severe bouts of coughing may be followed by an inspiratory whoop (particularly in young children) and, often, posttussive emesis.

Answer 26

pertussis

Question 27

teenager with parotitis following a nonspecific prodrome of fever, myalgias, and fatigue likely has ???

​​​​​​​ The virus has an affinity for glandular epithelium and classically causes parotitis, which can be unilateral or bilateral. Orchitis, a common complication, can develop in infected adolescent boys and young adults and impair fertility.

Answer 27

mumps

Question 28

patient developed a prolonged and progressive, nonblanching maculopapular rash in the neonatal period with involvement of the palms and soles, findings that warrant evaluation for ???

rash may start from bottom

Answer 28

congenital syphilis

Question 29

The most common pathogen isolated from sputum cultures in infants and young children with cystic fibrosis is ???

Answer 29

Staphylococcus aureus

Question 30

Management of most uncomplicated biliary cysts is ??? due to a dramatically increased malignancy risk (eg, cholangiocarcinoma, gallbladder cancer, pancreatic cancer) up to 30 times greater than unaffected patients

Answer 30

complete cyst resection at the time of diagnosis

Question 31

Blood-streaked stools in a well-appearing infant age <6 months are most commonly due to anal fissure or ?????

In this case, a normal rectal examination, history of loose stools (as opposed to constipation), and presence of mucus in the stool make ??? the most likely diagnosis.

Answer 31

food protein–induced allergic proctocolitis (FPIAP)

Question 32

management of food protein–induced allergic proctocolitis (FPIAP)

Answer 32

discontinue milk in MATERNAL diet

Question 33

neonate has jaundice, light-colored stools, and direct (conjugated) hyperbilirubinemia, findings concerning for ????

**prolonged jaundice for > 2weks; onset 2 weeks after birth is possible

a rare but potentially fatal disease characterized by progressive fibrosis and obliteration of the extrahepatic bile ducts

Answer 33

biliary atresia (BA)

US shows absence of gallbladder

cholangiography confirms diagnosis

Question 34

adolescent with type 1 diabetes mellitus (T1DM) has poor weight gain, abdominal discomfort, and recurrent hypoglycemia despite a healthy appetite, findings concerning for a malabsorptive disorder, such as ??

malabsorption can also lead to micronutrient deficiencies such as microcytic iron deficiency anemia (IDA)

Answer 34

celiac disease

higher incidence in pts with autoimmune conditions

Question 35

???? manifests as unconjugated hyperbilirubinemia and dehydration (eg, excessive weight loss, inadequate urine output) in the first week of life. Decreased elimination leads to inadequate bilirubin excretion and increased enterohepatic circulation.

Answer 35

Lactation failure jaundice (insufficient breast milk intake)

Question 36

infants typically require ??? feeds a day (every 2-3 hours) for the first few weeks of life.

Answer 36

8-12

Question 37

??? generally presents in the first 6 months of life (peak symptoms at age 4 months) with spit-up or vomiting of partially digested breast milk or formula after feeding. Condition does not cause discomfort while spitting up, and infants continue to feed eagerly, with normal weight gain. These infants are often called “happy spitters.” Diagnosis is clinical based on characteristic features and a normal examination.

Answer 37

gastroesophageal reflux (GER)

Question 38

infectious ileocecitis, often called pseudoappendicitis is caused by organisms that have a predilection for infecting the ileocecal region, specifically Yersinia enterocolitica and ???. Most patients develop RLQ pain

Answer 38

Campylobacter jejuni

Question 39

episodic inconsolable crying with legs flexed and drawn into the abdomen + Increasing lethargy + mild abdominal tenderness

????

Answer 39

intussusception

order abdominal ultrasound

Question 40

??? is defined as crying for no apparent reason for ≥3 hours a day for ≥3 days a week in an otherwise healthy infant age <3 months. Crying usually occurs around the same time of the day (eg, evening), and parents often have difficulty consoling the infant only during this time. Initial management includes providing parents with reassurance and support. Soothing techniques should be reviewed and include using a pacifier; holding, rocking, or swaddling the baby; and minimizing environmental stimuli (eg, dark room).

Answer 40

Colic

Question 41

Compared to term infants, preterm infants have a lower initial hematocrit at birth, a shorter erythrocyte life span, and ????

Therefore, their erythrocyte nadir tends to be more severe (eg, ~7 g/dL) and occur earlier (eg, 1-2 months), resulting in anemia or prematurity

Answer 41

less capacity to produce renal EPO.

Question 42

glucose-6-phosphate dehydrogenase (G6PD) deficiency is an enzyme that generates NADPH, a cofactor required to make glutathione. Without glutathione, oxidative metabolites (eg, superoxide anion, hydrogen peroxide) accumulate in erythrocytes and denature/precipitate hemoglobin into ???? (dark red erythrocyte inclusions), which reduce erythrocyte flexibility and lead to red cell damage (bite cells) and lysis in the reticuloendothelial system.

Answer 42

Heinz bodies

Question 43

episode patient developed dark-colored urine, elevated bilirubin, and anemia shortly after receiving antibiotics, raising strong suspicion for drug-induced hemolytic anemia. The most common triggers are nonsteroidal anti-inflammatory drugs (eg, diclofenac), penicillins (eg, piperacillin), and cephalosporins (eg, ceftriaxone)

how do you diagnose?

Answer 43

direct antiglobulin (Coombs) test, which detects IgG or C3 (a complement component) on the erythrocyte surface

Question 44

Individuals with sickle cell trait are generally asymptomatic and can lead a healthy life. Although patients are at increased risk for renal issues, the most common of these is ???

Answer 44

painless microscopic or gross hematuria that results from sickling in the renal medulla

Question 45

Premature and very low-birth-weight (<1.5 kg [3.3 lb]) infants are particularly vulnerable due to decreased bowel motility, increased intestinal permeability, and immature host defenses. Exposure to bacteria from enteral feeds, especially formula feeds, also increases the risk of ???

Answer 45

necrotizing enterocolitis (NEC)

Question 46

hallmark x-ray finding in necrotizing enterocolitis (NEC) is ?????

. In addition, portal venous air is seen as branching areas of lucency over the liver due to gas-producing bacteria and the transmigration of gas from the bowel wall to the mesenteric and portal veins. Severe intestinal necrosis can also cause perforation and pneumoperitoneum.

Answer 46

air in the bowel wall, or pneumatosis intestinalis

Question 47

Meckel diverticulum usually presents with painless rectal bleeding ± iron deficiency anemia

at what age does it normally present?

Answer 47

2 yrs

rule of 2’s

Presentation often by age 2 (but can occur at any age)

Usually <2 inches long

Location within 2 feet of ileocecal valve

Question 48

Imaging of meconium ileus classically reveals dilated loops of small bowel proximal to the obstruction with minimal or absent air distally in the colon and rectum. A soap-bubble gas pattern may be present in the ileum due to mixing of meconium with air.

???? test revealing microcolon is diagnostic of meconium ileus.

Answer 48

Water-soluble contrast enema

(microcolon, small colon from underuse)

Question 49

??? is characterized by 3 pathognomonic facial dysmorphisms:

Small palpebral fissures

Smooth philtrum (vertical groove above the upper lip)

Thin vermilion border

Answer 49

fetal alcohol syndrome

Question 50

Palpable peripheral lymph nodes are common in children and young adults. Reassuring features include palpation revealing small (<2 cm in diameter), soft, ?? and nodes that are localized to one area.

Answer 50

mobile

Question 51

Neonatal ?? infection presents in the first few weeks of life. Signs of umbilical infection are generally present, but the diffuse hypertonicity (opisthotonus) is the hallmark of neonatal tetanus. Feeding difficulty is due to trismus (lockjaw) from spasm of the muscles of mastication. Patients are at risk for life-threatening stridor and respiratory failure as the diaphragm and upper airway muscles contract.

Answer 51

tetanus

Question 52

which infection and management??

Answer 52

diagnosis of molluscum contagiosum is clinManagement in healthy children is reassurance and observation. ical, and symptoms typically self-resolve within 6-12 months

Question 53

The illness usually begins with nonspecific upper respiratory symptoms (eg, rhinorrhea, congestion) with subsequent development of fever, hoarseness, stridor (ie, high-pitched noise), and a harsh, barking, seal-like cough. The stridor worsens with agitation (eg, crying) or excitement and is typically inspiratory due to upper airway edema, but it may be biphasic (inspiratory and expiratory) in severe cases.

Answer 53

croup

parainfluenza

Question 54

typically presents with nocturnal perianal pruritus (pruritus ani). Transmission occurs via contact with contaminated objects (eg, bedding, clothing) or unwashed hands after scratching the perianal area

caused by?

Answer 54

Pinworm (Enterobius vermicularis) is a common helminth infection

Question 55

Pinworm (Enterobius vermicularis) is a common helminth infection

tx??

Answer 55

Treatment with albendazole or pyrantel pamoate

Question 56

patient with fever, malaise, exudative pharyngitis, cervical lymphadenopathy, and hepatosplenomegaly developed a polymorphous rash after taking amoxicillin. This presentation is most consistent with ???

Answer 56

infectious mononucleosis

Question 57

First-line therapy for acute otitis media with or without TM perforation is ??

most common pathogens causing AOM are Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis

Answer 57

amoxicillin-clavulanate

Question 58

infectious mono patients with marked oropharyngeal inflammation and severe tonsillar enlargement are at risk for ???, a rare but potentially fatal complication.

Answer 58

acute airway obstruction

Question 59

microcephaly with periventricular calcifications and ventriculomegaly (as seen in this patient) is highly suspicious for congenital ??

Answer 59

CMV

Question 60

Postexposure prophylaxis is indicated for newborns born to mothers with varicella developing 5 days before to 2 days after delivery. Prophylaxis is achieved by administering ??? to the infants, who are too young to receive live varicella-zoster virus vaccine.

Answer 60

varicella-specific immunoglobulin

Question 61

most common cause of early-onset (age <7 days) neonatal pneumonia is ??

Answer 61

Streptococcus agalactiae or group B Streptococcus (GBS)

Question 62

pathogenesis of minimal change disease begins with ???? that release cytokines (eg, IL-13) that damage the capillary wall of the glomerulus, leading to epithelial podocyte injury and loss of charge selectivity across the glomerular basement membrane.

Answer 62

dysregulation of T-cell subpopulations/Dysfunctional T cells

Question 63

nocturnal enuresis + child is irritable and inattentive with tonsillar hypertrophy. These findings are concerning for ???

Answer 63

obstructive sleep apnea (OSA)

.Evaluation of OSA is with nocturnal polysomnography (ie, sleep study), which detects and quantifies respiratory pauses and desaturations during sleep

Question 64

Recurrent urinary tract infections (UTIs) in infants and children + renal scintigraphy with dimercaptosuccinic acid shows bilateral focal parenchymal scarring and blunted calyces

caused by???

Answer 64

primary vesicoureteral reflux (VUR). ​​​

Question 65

When administered in patients with hypovolemia (eg, vomiting, diarrhea), NSAIDs inhibit the COX enzymes and reduce prostaglandin synthesis, resulting in ??? and subsequent reduced glomerular filtration rate, renal ischemia, and acute kidney injury.

Answer 65

renal afferent arterial vasoconstriction

Question 66

??? play a large role in the pathogenesis of primary nocturnal enuresis

??? is the greatest risk factor

Answer 66

Genetic factors

family history of bed wetting

Question 67

Constipation is commonly associated with bladder dysfunction and should be considered in any patient with enuresis.

Although often mistaken as diarrhea, encopresis (ie, fecal incontinence) is usually a sign of constipation and is characterized by leakage around impacted stool. ​​​​​​​In patients with encopresis, ??? therapy often resolves both constipation and enuresis.

Answer 67

laxative (eg, polyethylene glycol)

Question 68

?? is the most common cause of urinary tract obstruction in newborn boys.

In utero this causes oligohydramnios and subsequent lung hypoplasia, which can lead to diminished lung volumes and postnatal respiratory distress (eg, hypoxia, tachypnea, decreased breath sounds)

Answer 68

posterior urethral valves (PUV)

Question 69

child with a history of frequent urinary tract infections (UTIs) has fatigue, hypertension, and proteinuria in addition to daytime and nighttime enuresis. These findings are concerning for ??

Answer 69

chronic kidney disease (CKD)

most likely secondary to posterior urethra valves

Question 70

tumor lysis syndrome can cause acute kidney injury how???

Answer 70

obstructing uric acid stones in the renal tubules ​​​​​​and/or obstructing calcium-phosphate stones

Question 71

Initial evaluation of glomerulonephritis includes ??? , as well as a complete blood count and albumin level.

Answer 71

serum complement (C3, C4) levels

Question 72

Diagnosis is confirmed by renal biopsy, with electron microscopy showing a lamellated GBM due to longitudinal splitting of the lamina densa

Answer 72

alport syndrome

*also sensorineural hearing loss

Question 73

The first step in evaluating clinically evident spinal asymmetry is ???

Answer 73

x-ray of the spine. Full-back posteroanterior and lateral radiographs confirm the diagnosis, measure the severity of disease (ie, Cobb angle), and assess skeletal maturity.

Question 74

Classic manifestations include nonblanching palpable purpura on the legs and buttocks, lower extremity arthralgia/arthritis (which can result in refusal to ambulate), abdominal pain, and renal disease (hematuria ± proteinuria).

Answer 74

​​​​​​​Henoch-Schönlein purpura (HSP), an IgA-mediated, small-vessel vasculitis

Question 75

Patients with Henoch-Schönlein purpura (HSP) are at increased risk for which GI issue?

Answer 75

ileoileal intussusception due to intestinal edema and bleeding

Question 76

child has a lytic bone lesion, rash, and signs of diabetes insipidus (ie, polyuria, hypernatremia) consistent with ??

Answer 76

Langerhans cell histiocytosis (LCH)

Question 77

??? is an autosomal dominant connective tissue disorder caused by mutations in the type I collagen (COL1A1) gene. Patients typically present with recurrent fractures, joint hypermobility, short stature, and hearing loss.

Answer 77

​​​​​​​Osteogenesis imperfecta

Question 78

??? is the anterior slippage of a vertebral body due to bilateral defects of the pars interarticularis (spondylolysis). It classically presents in adolescents with low back pain exacerbated by lumbar extension.

Answer 78

Spondylolisthesis

+ numbness, paresthesias, muscle weakness, gait problems

often associated with repetitive hyperextension of the spine (e.g., in gymnasts, swimmers, or weight lifters)

can be congenital as well

Question 79

patient’s fever, rash, migratory polyarthritis (particularly in the wrists, ankles, and knees), and elevated acute-phase reactants (C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR]) satisfy the diagnostic criteria for ???

Answer 79

acute rheumatic fever

Question 80

Findings include enlarged or delayed closure of fontanels, wrist enlargement, and craniotabes (soft skull bones). Progressive, symmetric or asymmetric bowing of the femurs and tibias may occur after children become weight-bearing, as seen here. Widening of the costochondral joints (“rachitic rosary”) on the anterior chest is common and may appear as bony prominences on examination.

Answer 80

​​​​​​​nutritional rickets due to a deficiency in vitamin D

Question 81

??? is a serious complication that develops in a minority of patients with oligoarticular juvenile idiopathic arthritis (JIA)

Answer 81

uveitis (ie, intraocular inflammation)

Ophthalmologic screening examinations are performed regularly because untreated uveitis is often asymptomatic and can lead to irreversible vision loss

Question 82

??? is characterized by arthritis involving ≤4 joints. Patients are classically girls age <5. Joint swelling is present, but pain may be minimal. The large joints (eg, knees, ankles) are most commonly affected; however, hip involvement is rare. Systemic symptoms (eg, fever, rash) do not occur.

Answer 82

oligoarticular form of juvenile idiopathic arthritis (JIA)

Question 83

Patients are generally well-appearing and afebrile without laboratory evidence of significant infection or inflammation. Treatment is supportive, including nonsteroidal anti-inflammatories (eg, ibuprofen). Ultrasound may reveal small, unilateral or bilateral hip effusions.

Answer 83

Transient synovitis (of the hip)

Question 84

?? is most common in children and is typically triggered by beta-lactam (eg, cefaclor) and sulfa drugs. Symptoms begin 5-14 days after exposure and include urticarial rash, arthralgia, lymphadenopathy, and low-grade fever

Answer 84

Serum sickness–like reaction

Question 85

x-ray imaging classically reveals a lamellated periosteal reaction in which a central, poorly defined lytic lesion is surrounded by concentric layers of new bone (“onion skinning”). A “moth-eaten” or mottled appearance can also occur with extension into soft tissue.

Answer 85

Ewing sarcoma

Question 86

dolescent idiopathic scoliosis (ie, lateral curvature of the spine) typically progresses until growth and bone ossification are complete. Risk factors associated with curve progression include female sex, skeletal immaturity, initial severe curvature, and ????

Answer 86

age <12, premenarchal status

Question 87

Observation alone is recommended for children with immune thrombocytopenia (ITP) with only cutaneous symptoms (eg, petechiae), regardless of platelet count. The course is usually self-limited with spontaneous recovery within 3 months. Glucocorticoids, anti-D immune globulin (if Rh-positive and Coombs-negative), or intravenous immunoglobulin is first-line treatment in children with ???

Answer 87

mucosal bleeding

Question 88

Urticarial transfusion reactions are common and typically mild. Pathogenesis involves histamine release due to preformed ???? reacting against a soluble allergen in the donated plasma

Answer 88

recipient IgE antibodies

Question 89

??? is a congenital, pure red cell aplasia characterized by macrocytic anemia and several congenital abnormalities, such as cleft palate, webbed neck, and triphalangeal thumbs.

Answer 89

Diamond-Blackfan anemia

Question 90

Bone pain and pancytopenia in a child are concerning for ???

Other characteristic findings include fever, pallor, bruising, and hepatosplenomegaly.

Answer 90

acute lymphoblastic leukemia

Question 91

Platelet dysfunction is common in patients with chronic kidney disease due to ???

Answer 91

As levels of urea (the end product of ammonia breakdown) rise, its precursors are shunted to a different pathway that leads to nitric oxide production. Inappropriately high nitric oxide results in decreased platelet adhesion, activation, and aggregation

Question 92

thalasemmia vs. iron def microcytic anemia

Answer 92

IDA = include decreased erythrocyte count (inadequate synthesis) and elevated red cell distribution width due to variable iron levels available throughout the day. In addition, IDA may be associated with reactive thrombocytosis (platelets >400,000/mm3) in response to low red blood cell count

Question 93

??? is defined as a hematocrit level >65% in term neonates. Risk factors include excessive transfusion, intrauterine hypoxia, and maternal diabetes. High blood viscosity limits organ perfusion and can cause respiratory distress, hypoglycemia, and poor feeding.

Answer 93

Polycythemia

Question 94

Beta-thalassemia major is transfusion-dependent. The additional iron from transfused RBCs increases the risk for iron overload. ??? therapy is required to avoid damage to the liver, kidneys, and endocrine glands and improve survival.

Answer 94

Chelation

Question 95

??? syndrome is an X-linked disorder characterized by the triad of thrombocytopenia, eczema, and recurrent infections. The thrombocytopenia is the most consistent feature and is characterized by a significant reduction in platelet volume and size.

Answer 95

Wiskott-Aldrich

Question 96

patient with cystic fibrosis (CF) has bruising and epistaxis likely due to ???

Answer 96

deficiency of vitamin K, a fat-soluble vitamin. Patients with CF are at increased risk for vitamin K deficiency because defective chloride transport causes viscous exocrine secretions to block pancreatic ducts, leading to pancreatic insufficiency

Question 97

neonate who has not received prior medical care has bruising and prolonged PT and PTT, findings concerning for ???

Answer 97

vitamin K–deficient bleeding (VKDB).

Question 98

??? syndrome is a genetic condition characterized by hyperpigmented mucocutaneous macules, gastrointestinal polyps that can bleed and cause iron deficiency anemia, and an increased risk for malignancy. Upper and lower endoscopies are performed regularly to screen for polyps and cancer.

Answer 98

Peutz-Jeghers

Question 99

what are performed regularly for patients with Peutz-Jeghers??

Answer 99

Upper and lower endoscopies are performed regularly to screen for polyps and cancer.

Question 100

??? in children may present with distressing dreams with vague content and reenactment of traumatic themes in play, rather than clearly formulated memories. This is often accompanied by emotional dysregulation and behavioral difficulties.

Answer 100

Posttraumatic stress disorder

Question 101

In children and adolescents with depression, considerations for inpatient treatment include suicidal ideation, poor psychosocial support, and lack of psychiatric follow-up. Any child who has possible thoughts of suicide must undergo ??

Answer 101

emergency assessment for safety.

Question 102

Apnea of prematurity is caused by immature central respiratory centers and presents with respiratory pauses, often with bradycardia and desaturation. Treatment involves noninvasive ventilation and ???

Answer 102

caffeine

Question 103

Neonatal respiratory distress syndrome presents with increased work of breathing, hypoxia responsive to oxygen, and ground-glass opacities on x-ray; management includes administration of ??

Answer 103

exogenous surfactant

Question 104

Increased brightness over the affected lung on transillumination of the chest is supportive of the diagnosis of???

Answer 104

pneumothorax

hemodynamic instability or signs of tension pneumothorax (eg, mediastinal shift) warrant emergency needle thoracostomy.

Question 105

Bronchiolitis is most commonly caused by respiratory syncytial virus and manifests as upper respiratory symptoms, wheezing/crackles, and respiratory distress. Neonates are especially vulnerable to complications such as ???

Answer 105

apnea and respiratory failure

Question 106

Transfusion-associated circulatory overload can occur when a large volume of blood product is rapidly transfused, particularly in children age <3 with chronic anemia. Signs include respiratory distress, hypertension, tachycardia, and pulmonary edema within 6 hours of transfusion initiation. Management includes ???

Answer 106

diuresis (eg, furosemide)

Question 107

first step in management of a newborn with suspected congenital diaphragmatic hernia is ???

Answer 107

endotracheal intubation. A gastric tube should also be placed immediately to decompress the stomach and bowel.

Question 108

Children with pneumonia on appropriate antimicrobial therapy who have no improvement after 48-72 hours require evaluation with ??? to assess for complications (eg, parapneumonic effusion).

Answer 108

chest x-ray

Question 109

term newborn with increased work of breathing and fluid-filled fissures has ???, a condition caused by delayed resorption and clearance of pulmonary fluid

Answer 109

transient tachypnea of the newborn (TTN)

Question 110

which infection?

Chest x-ray findings may include increased interstitial markings and peribronchal cuffing (haziness around the bronchial wall, reflecting airway inflammation), as seen in this patient. Hyperinflation and atelectasis may also be present, and the absence of a focal consolidation is typical.

Answer 110

viral bronchiolitis, a lower respiratory tract infection in children age <2 years that is most commonly caused by respiratory syncytial virus

Question 111

Nonbullous impetigo is characterized by papules and pustules with overlying honey-colored crusting. ???? are the treatment of choice for localized infection.

Answer 111

Topical antibiotics (eg, mupirocin)

Question 112

Unlike typical causes of CAP (eg, Streptococcus pneumoniae), which cause lobar infiltrate on chest x-ray, patients with ??? usually have bilateral reticulonodular or patchy pulmonary infiltrates

Answer 112

M pneumoniae

Question 113

Treatment with ??? is first-line for mycoplasma pneumo; beta-lactams are ineffective because the organism lacks a cell wall.

Answer 113

azithromycin

Question 114

??? is the most common cause of neonatal sepsis and meningitis. Prevention of early-onset infection includes maternal screening before delivery and intrapartum antibiotic prophylaxis, but these measures do not decrease the risk of late-onset (age >1 week) infection.

Answer 114

Group B Streptococcus

Question 115

the most common risk factor for acute bacterial rhinosinusitis (ABRS) is ??

Answer 115

viral upper respiratory infection (URI)

Question 116

??? is defined by any 1 of the following 3 criteria:

Symptoms (eg, cough, nasal discharge/congestion) persisting for ≥10 days without improvement

Symptoms severe in onset (fever ≥39 C [102.2 F] + drainage) for ≥3 days

Symptoms worsening following initial improvement

Answer 116

acute bacterial rhinosinusitis (ABRS)

Question 117

When infectious diarrhea is prolonged (≥2 weeks), the causative pathogen is typically (1???) rather than bacterial or viral. The presence of blood in the stool makes (2??)infection the most likely diagnosis.

Answer 117

parasitic

Entamoeba histolytica

Question 118

Patients have gray vesicles that progress to fibrin-coated ulcers. The oral enanthem is located in the oropharynx on the posterior soft palate, anterior palatine pillars, tonsils, and uvula.

It typically presents with fever and oropharyngeal vesicles and ulcers on the posterior soft palate, palatine pillars, tonsils, and uvula.

Answer 118

​​​​​​​Herpangina caused by Coxsackie virus infection.

Question 119

Laboratory evidence of DIC includes thrombocytopenia, elevated PT and PTT, and low ?? .

Answer 119

fibrinogen

Question 120

Congenital ?? classically presents with hydrocephalus/macrocephalus and diffuse intracranial calcifications. Maternal acquisition of is due most commonly to ingestion of cat feces or undercooked meat from animals

Answer 120

toxoplasmosis

Question 121

abdominal US shows this

what is the diagnosis and treatment?

Answer 121

Intusseception

tx first with air enema

Question 122

??? is a common, benign cause of indirect hyperbilirubinemia on days 2-4 of life. Mechanisms include increased bilirubin production, decreased bilirubin clearance, and increased enterohepatic recycling.

Answer 122

Physiologic jaundice of the newborn

Question 123

The rotavirus vaccine is contraindicated in patients with a history of ??? due to the small risk of this complication.

Answer 123

intussusception

Question 124

??? is the only definitive therapy severe combined immunodeficiency (SCID).

Answer 124

Stem cell transplantation

Question 125

SCID is a severe primary immunodeficiency caused by one of several gene defects leading to failure of ???. Without cellular immunity, patients with SCID are at high risk for infections with viruses, fungi (eg, Candida [thrush]), and opportunistic pathogens (eg, Pneumocystis jirovecii).

Answer 125

T cell development

The loss of helper T cell function also causes B cell dysfunction (ie, impaired humoral immunity) and recurrent sinopulmonary bacterial infections (eg, pneumonia, otitis media).

Question 126

patient’s recurrent pneumonias, Giardia infection, and small tonsils are suggestive of ???

Answer 126

X-linked agammaglobulinemia (XLA)

Question 127

Bruton agammaglobulinemia or XLA is caused by a genetic defect in Bruton tyrosine kinase, resulting in ???

Answer 127

abnormal B-lymphocyte maturation

Low B-cell concentrations lead to small or absent lymphoid tissue (eg, tonsils, adenoids) and severely decreased serum immunoglobulin concentrations.

Question 128

???? presents with recurrent, nonpurulent skin and mucosal bacterial infections, as well as severe periodontal disease. Marked leukocytosis with a neutrophil predominance is common.

Answer 128

Leukocyte adhesion deficiency

Question 129

Patients with chronic granulomatous disease (CGD) should receive prophylaxis with (2)

Answer 129

trimethoprim-sulfamethoxazole and antifungal prophylaxis with itraconazole.

Question 130

which pathogens for chronic granulomatous disease (CGD)??

Staphylococcus aureus, Burkholderia (Pseudomonas) cepacia, Serratia marcescens, Nocardia, and???

Answer 130

Aspergillus.

Question 131

Diagnosis of hereditary angioedema is supported by complement testing showing ??? levels, which are caused by exaggerated cleavage by uninhibited C1 complex. Low levels of C1 inhibitor protein or C1 inhibitor function confirm the diagnosis.

Answer 131

low C4

Question 132

​​​​​​​ ??? is caused by abnormal B-cell differentiation, leading to decreased immunoglobulin production. Lymphocyte and B-cell concentrations are generally normal. typically presents in early adulthood or adolescence with recurrent sinopulmonary and gastrointestinal (eg, Giardia) infections, failure to thrive, and chronic pulmonary disease. Treatment is intravenous immunoglobulins.

Answer 132

Common variable immunodeficiency (CVID)

.

Question 133

Common variable immunodeficiency (CVID)

Treatment is ??

Answer 133

intravenous immunoglobulins.

Question 134

??? is a subperiosteal hemorrhage that occurs due to rupture of subperiosteal blood vessels during delivery. Blood collects between the skull and the periosteum but is limited to the surface of a single cranial bone. Forceps or vacuum-assisted deliveries increase the risk

Examination reveals nontender, firm, well-demarcated scalp swelling that does not cross suture lines.

Answer 134

Cephalohematoma

Question 135

Subependymal giant cell tumor is the classic CNS lesion in ???

children have infantile spasms, seizures that typically present in infancy with clusters of brief muscle contractions, which can appear similar to exaggerated startles (eg, flexion of neck) and abdominal crunches (eg, flexion of trunk and extremities)

Answer 135

(TSC) Tuberous sclerosis complex

Question 136

Holosystolic or diastolic

Harsh

Grade ≥3 intensity

Intensity persists with standing & Valsalva maneuver

all signs of????

Answer 136

pathologic murmur

needs workup (probably ECHO)

Question 137

?? are congenital malformations of the great vessels that encircle and compress the trachea and/or esophagus. Respiratory symptoms may include biphasic stridor that improves with neck extension. Esophageal symptoms include dysphagia, vomiting, and difficulty feeding.

Answer 137

Vascular rings

Question 138

infant has poor perfusion (eg, cold, pale extremities) and manifestations of congestive heart failure (eg, poor feeding, crackles, gallop, hepatomegaly) that developed around the time of expected closure of the ductus arteriosus (first few days of life) AND differential pulses and mild oxygen saturation gap between the upper and lower extremities suggests ???

Answer 138

aortic coarctation, a ductal dependent congenital heart lesion

Aortic arch narrowing (due to a thickened tunica media) leads to decreased blood flow to the descending aorta.

Question 139

Persistent pulmonary hypertension of the newborn is characterized by abnormal persistence of elevated ????, causing right-to-left shunting across a patent ductus arteriosus.

Answer 139

pulmonary vascular resistance

Question 140

Myocarditis is a potentially lethal disorder of the myocardium and is most commonly caused, in children, by ???

Answer 140

viral infection (eg, Coxsackievirus B, adenovirus)

Question 141

A viral prodrome (eg, upper respiratory infection [URI]) often precedes the illness. Patients then typically develop chest pain and respiratory distress (eg, dyspnea, tachypnea, wheezing, crackles) from acute left heart failure and pulmonary edema. Dilated cardiomyopathy with mitral regurgitation can cause an S3 gallop and holosystolic murmur

Answer 141

viral myocarditis

Question 142

viral myocarditis can cause what change in heart structure?

Answer 142

Dilated cardiomyopathy with mitral regurgitation that can cause an S3 gallop and holosystolic murmur

Question 143

In infants, VSDs may present with tachypnea, tachycardia, and poor feeding due to high-output heart failure and ???

Answer 143

pulmonary overcirculation

With a large VSD, the right ventricle becomes volume overloaded with flow from both the right atrium and left ventricle. In turn, pulmonary blood flow and left-sided blood return increase. To maintain systemic blood flow, left ventricular (LV) output increases but cannot keep up with the increased blood return, resulting in high-output cardiac failure.

Question 144

Patients with a history of acute rheumatic fever are at risk of progressive rheumatic heart disease from recurrent group A Streptococcus pharyngitis. Treatment with ?? prophylaxis is necessary

Answer 144

penicillin

prevents streptococcal infections and limits the progression of heart disease.

Question 145

Persistent pulmonary hypertension of the newborn (PPHN) can be caused by conditions that injure the lungs (eg, meconium aspiration syndrome). Treatment of PPHN includes oxygenation, ventilation, and administration of ???

Answer 145

pulmonary vasodilators (eg, inhaled nitric oxide)

decreases PVR and reduces right-to-left shunting through the ductus arteriosus.

Question 146

???? cardiomyopathy may be seen in infants of diabetic mothers due to myocardial fat and glycogen deposition.

Answer 146

Transient hypertrophic cardiomyopathy

spontaneously regress by age 1 due to normalization of insulin levels

Question 147

This infant has ???, or cyanosis of the hands and feet due to benign peripheral vasospasm. It is a normal finding in newborns, and pulse oximetry shows normal oxygen saturation levels.

Answer 147

acrocyanosis

Question 148

Secondary hypogonadism is a common adverse effect of which drugs???. The drug suppress GnRH and LH secretion, leading to reduced Leydig cell testosterone synthesis, decreased spermatogenesis, and testicular atrophy. Additional manifestations can include depression, hot flashes, and osteoporosis. In women, menstrual irregularities are common

Answer 148

Opioids

(also glucocorticoids)

Question 149

??? is characterized by poorly localized lateral knee pain. It is common in inexperienced runners starting a new or more strenuous training regimen. Examination shows tenderness proximal to the joint line; pressure just proximal to the lateral femoral epicondyle during flexion of the knee reproduces the pain

Answer 149

Iliotibial (IT) band syndrome

Question 150

Vision is evaluated when in kids??

Answer 150

at every well-child visit, as early detection of eye abnormalities can prevent long-term vision loss. Formal visual acuity testing is recommended starting at age 4 as well as in cooperative 3-year-olds.

Question 151

??? presents with follicular conjunctivitis and inflammation of the tarsal conjunctivae. Repeated or chronic infection causes inversion of the eyelashes and scarring of the cornea. It is the leading infectious cause of blindness worldwide

Answer 151

Acute trachoma caused by Chlamydia trachomatis

Question 152

Although most cases of strabismus are idiopathic or related to convergence insufficiency, the underlying condition can be life-threatening (eg, intraorbital mass, increased intracranial pressure). Therefore, the first step in evaluation is a ??? to assess for secondary causes, particularly retinoblastoma, an intraocular malignancy that can often be visualized on funduscopy as a nodular, cream-colored retinal mass.

Answer 152

dilated funduscopic examination

Question 153

Normal ocular alignment results in symmetric corneal light reflexes in the center of the eye and bilateral red reflexes that are equal in color and brightness. In contrast, a child’s right eye esotropia (nasal deviation) and abnormal red reflexes are findings consistent with ??? , or ocular misalignment.

Answer 153

strabismus

Untreated strabismus can lead to amblyopia, or decreased visual acuity of the improperly aligned eye.

Question 154

Chlamydial conjunctivitis typically presents at age 5-14 days (not immedietly at birth) with mild eyelid swelling, chemosis, and watery or mucopurulent discharge. Management is ???; topical treatments are not effective.

Answer 154

oral erythromycin

Question 155

​​​​​​​Septic prepatellar bursitis is characterized by acute erythema, warmth, and pain accompanying bursal swelling. It is usually caused by skin breakage that allows entry of skin floras (eg, Staphylococcus). ??? analysis is needed to confirm the diagnosis. Treatment includes systemic antibiotics.

Answer 155

Bursal fluid analysis

not aspiration from knee joint

Question 156

A 16-year-old girl is brought to the office due to pain in multiple joints. The pain has primarily been in her left knee and hip,right shoulder, and both wrist and hand joints. The patient says the pain seemed to be in one joint and would improve after a day or 2 before moving to a different joint. She also notes that she had 2 days of fever and malaise a week ago, but these have since resolved. Physical examination shows tenderness and pain on movement of the bilateral wrists and left fingers. There is mild swelling and tenderness of the left knee with no erythema. Several 3- to 4-mm, nontender pustules with a surrounding erythematous rim are present on the left lower extremity. Left knee arthrocentesis yields clear synovial fluid with a leukocyte count of 30,000/mm3. Synovial fluid culture is negative

which infection??

Answer 156

disseminated gonococcal infx

Question 157

???? results from direct trauma to the superior or lateral shoulder. Examination shows maximal tenderness over the AC joint and pain with adduction of the arm across the torso. X-rays can assess the degree of sprain and evaluate for concomitant clavicular or humeral fractures.

Answer 157

Acromioclavicular (AC) joint sprain

Question 158

Buckle fractures are common in children and typically occur at the distal radius and/or ulna due to a fall onto an outstretched hand. X-ray is diagnostic and shows ??

Answer 158

bulging of the bony cortex

Question 159

Screening for osteoporosis with dual-energy x-ray absorptiometry is recommended in all women age > ???

If the patient has multiple risk factors for osteoporosis (eg, weight <58 kg [127 lb], smoking, parental history of hip fracture, early menopause), then the risk should be estimated using the FRAX fracture risk assessment tool. If the risk is high enough, then osteoporosis screening at an earlier age may be appropriate

Answer 159

65

Question 160

Patellofemoral pain syndrome is a common cause of chronic anterior knee pain in women. Diagnosis is based on clinical findings; symptoms are typically reproducible with ?? .Atrophy or weakness of the quadriceps or hip abductors is common, and rotational or varus/valgus malalignment may be noted. Treatment includes strengthening the quadriceps and hip abductors.

Answer 160

isometric quadriceps contraction (eg, squatting).

Question 161

Acute Achilles tendinopathy vs. Subcutaneous calcaneal vs. Calcaneal apophysitis

Answer 161

Acute Achilles tendinopathy presents with posterior ankle pain and tenderness and typically occurs in athletes and other active people following an increase in activity or exercise. The diagnosis is based on clinical findings, which include pain, swelling, and tenderness approximately 2-6 cm proximal to the insertion of the tendon on the calcaneus

Subcutaneous calcaneal (superficial to the tendon) bursitis presents with pain and tenderness at the calcaneal prominence (Achilles tendon insertion point)

​​​​​​​Calcaneal apophysitis (Sever disease) is a common cause of posterior heel pain and tenderness. However, it usually occurs in children and adolescents who participate in running or jumping sports (eg, basketball) because the apophysis is most susceptible to stress during periods of rapid growth. Also, the findings are typically seen within 2 cm of the insertion of the Achilles tendon.

Question 162

Suspected developmental dysplasia of the hip (eg, asymmetric gluteal/thigh/inguinal creases, apparent leg-length discrepancy) in early infancy should be evaluated with ???

Answer 162

hip ultrasound

Question 163

????, which causes hip pain and limp, is characterized by displacement of the proximal femur relative to the femoral head along the growth plate. Obesity is a risk factor, but may also be seen in tall, thin adolescents during periods of accelerated growt

Answer 163

Slipped capital femoral epiphysis (SCFE)

Question 164

????, or idiopathic avascular necrosis of the hip, most commonly affects boys age 5-7 and presents with insidious onset of hip pain and limp. X-ray may be normal in early disease or show fragmentation of the femoral head, not displacement of the femoral head.

Answer 164

Legg-Calvé-Perthes disease

Question 165

This patient has painon the radial side of the wrist consistent with ???? an overuse syndrome involving the tendons of the abductor pollicis longus and extensor pollicis brevis and occurs most prominently at the point where the tendons pass under the extensor retinaculum in the first dorsal compartment. It most commonly occurs in women age 30-50 and is frequently seen 4-6 weeks postpartum, possibly due to repetitive thumb abduction and extension when lifting the infant.

Answer 165

de Quervain tendinopathy (DQT)

Question 166

This young patient has had fever ≥5 days, plus conjunctivitis, mucositis (ie, red, cracked lips), rash, and extremity changes, findings consistent with ????. Nonspecific gastrointestinal (eg, vomiting, diarrhea) or respiratory (eg, cough, congestion) symptoms may precede the development of mucocutaneous findings, as seen here.

Laboratory evidence supportive of systemic inflammation in KD includes leukocytosis and thrombocytosis, as seen in this case. Sterile pyuria, which represents urethral inflammation, is also classic and characterized by urinary white blood cells with no bacteriuria. Although mild anemia is common, this patient’s elevated hematocrit may represent hemoconcentration from poor fluid intake

Answer 166

Kawasaki disease (KD)

Question 167

Treatment of Kawasaki disease (KD)?

Answer 167

intravenous immunoglobulin (IVIG). Presumably due to its anti-inflammatory effect, IVIG decreases the risk of coronary artery aneurysms, which is highest in patients with delayed treatment. Therefore, IVIG therapy should be initiated within 10 days of symptom onset in all patients with KD. Aspirin is also administered for its anti-inflammatory and antiplatelet effects but does not affect aneurysm development.

Question 168

Initial management of hand osteoarthritis includes stretching and strengthening exercises. OA of the hands is primarily a clinical diagnosis; distal interphalangeal joint involvement is classic, and bony enlargement at the distal and proximal interphalangeal joints (ie, Heberden and Bouchard nodes) is pathognomonic for OA and often associated with a strong family history of the condition

???? are beneficial for most patients; oral NSAIDs are also effective but carry a greater risk for toxicity (eg, peptic ulcer)

Answer 168

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, diclofenac)

Question 169

Arterial supply to the ??? bone enters at the distal pole; fracture can disrupt flow to the proximal segment, leading to avascular necrosis and nonunion. fractures are characterized by tenderness in the anatomic snuffbox Nondisplaced fractures may not be immediately visible on x-ray. If initial x-rays are negative, CT scan or MRI is recommended, or the wrist should be immobilized and x-rays repeated after 7-10 days.

Answer 169

scaphoid

Question 170

??? is an overuse syndrome involving the tendons of the gluteus medius and minimus. It typically presents with chronic lateral hip pain that is worsened with repetitive hip flexion (eg, climbing stairs, walking uphill) or lying on the affected side. Physical examination shows local tenderness over the lateral hip during flexion. Hip range of motion is normal, although abduction may aggravate the pain. X-ray is commonly performed to rule out concurrent hip joint disorders; ultrasound may show chronic degeneration/tendinosis in the affected tendons.

Initial treatment includes local heat, activity modification, and nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with persistent symptoms despite conservative therapy often benefit from local corticosteroid injection, which is generally safe and provides rapid pain relief.

Answer 170

greater trochanteric pain syndrome (GTPS).

Question 171

Suprascapular nerve entrapment presents with shoulder pain and weakness of shoulder abduction and external rotation. It can be caused by external compression of the nerve at the suprascapular notch often with ???, a direct blow, or repetitive motion at the shoulder.

Answer 171

a heavy back pack

**think hiker

Question 172

pain is felt over the plantar heel/hindfoot and is often worse when first standing from rest, improves with activity, then worsens after long periods of weight bearing (eg, end of waitressing shift). Examination shows tenderness at the insertion of the plantar aponeurosis at the calcaneus (eg, anteromedial heel), especially with the toes passively dorsiflexed. The diagnosis is based on clinical findings; no imaging is necessary

Answer 172

plantar fasciitis, a chronic degenerative condition of the plantar aponeurosis at its insertion on the calcaneus. The plantar aponeurosis is a thick, fibrous band that extends from the calcaneus to the metatarsal heads and supports the arch of the foot

Question 173

patient has chronic shoulder pain with decreased passive and active range of motion (ROM), consistent with ??? (sometimes termed frozen shoulder). It is characterized by loss of the normal distensibility of the glenohumeral joint capsule due to chronic inflammation, fibrosis, and contracture. It is most common in middle-aged and older individuals, and the risk is increased in patients with diabetes mellitus, thyroid disorders, and chronic immobility. It is also common in patients with rotator cuff tendinopathy or fracture of the proximal humerus.

Answer 173

Adhesive capsulitis

Question 174

??? is characterized by quotidian fever for ≥2 weeks, fixed arthritis for ≥6 weeks, and a pink macular rash that worsens during fever. Laboratory evaluation typically reveals leukocytosis, thrombocytosis, elevated inflammatory markers, and anemia.

Answer 174

Systemic juvenile idiopathic arthritis

Question 175

Polyarticular juvenile idiopathic arthritis (JIA) presents as joint pain and stiffness involving ≥5 joints that is worse in the morning and improves over the course of the day. Individuals with polyarticular JIA are predominantly female, and the incidence peaks during adolescence and the toddler years. ??? are the first-line treatment.

Answer 175

Nonsteroidal anti-inflammatory drugs (eg, naproxen)

Question 176

Kawasaki disease is a systemic vasculitis that is most common in children age <5 of East Asian ancestry. In addition to prolonged fever (≥5 days), patients have at least ?? of the 5 following mucocutaneous findings:

Conjunctivitis: bilateral, nonexudative, limbus sparing

Oral mucosal changes: erythema, fissured lips, strawberry tongue

Polymorphous rash: often begins in perineal area

Distal extremity changes: erythema, edema, desquamation of the hands and feet

Cervical lymphadenopathy: >1.5-cm node

Answer 176

4

Question 177

​​​​​​​Slipped capital femoral epiphysis, which occurs most commonly among obese adolescents, is characterized by proximal femoral displacement relative to the femoral head along the growth plate. ??? involvement is common and may present with chronic hip, thigh, or knee pain and a waddling gait

Answer 177

Bilateral

Question 178

?? is a connective tissue disorder that presents with frequent fractures, joint hypermobility, hearing loss, and short stature

Answer 178

Osteogenesis imperfecta (blue sclera)

Question 179

Congenital muscular torticollis is a postural neck deformity due to ???? and presents with ipsilateral head tilt and contralateral chin deviation. A fibrotic neck mass may be present on examination, and limited range of motion of the neck increases the risk of positional plagiocephaly.

Answer 179

tightening of the sternocleidomastoid muscle

Question 180

patient’s hip arthralgia (or other LE arthralgia), abdominal pain, and lower-extremity petechial rash are consistent with ???

Diagnosis is clinical based on triad; no testing is necessary

Answer 180

Henoch-Schönlein purpura (HSP), or IgA vasculitis, the most common vasculitis in children.

Question 181

??? is a self-limiting, inflammatory hip condition most common in children age 3-8. Presentation may include limp (with ability to bear weight), hip pain, or pain referred to the knee. Most patients are afebrile (or low grade fever) with normal laboratory studies (eg, white blood cell count, C-reactive protein) and small, bilateral hip effusions.

Answer 181

Transient synovitis

Question 182

Acute, atraumatic hip pain in children is typically caused by transient synovitis, which presents in well-appearing children who are often afebrile and able to ambulate. However, patients with features concerning for septic arthritis (eg, inability to ambulate, leukocytosis) require ???, with or without arthrocentesis, to distinguish between the conditions

Answer 182

bilateral hip ultrasound

Question 183

​​​​​​​?? are benign capillary tumors of childhood. They typically appear during the first weeks of life, initially grow rapidly, and regress spontaneously. Complicated lesions may require treatment with beta blockers.

Answer 183

​​​​​​​Superficial infantile hemangiomas

aka strawberry hemangiomas

Question 184

This child with atopic dermatitis has a painful, vesicular rash and fever, findings concerning for ???

Answer 184

Eczema herpeticum is a potentially fatal cutaneous herpes simplex virus infection associated with atopic dermatitis. Classic presentation includes systemic symptoms (eg, fever, lymphadenopathy) and painful vesicles with “punched-out” erosions and hemorrhagic crusts.

Question 185

??? most commonly occurs in children and immunocompromised patients. It causes a scaly, erythematous patch that can progress to alopecia with inflammation, lymphadenopathy, and scarring. Oral griseofulvin or terbinafine are the preferred initial treatment options.

Answer 185

Tinea capitis is a superficial dermatophytosis

Question 186

??? is a benign neonatal rash that presents within the first 3 days of life as erythematous macules, papules, or pustules on the trunk and proximal extremities, sparing the palms and soles. Patients are otherwise asymptomatic, no treatment is required, and the rash self-resolves within a week.

Answer 186

Erythema toxicum neonatorum

Question 187

patient has chronic, scaly, irregular, erythematous plaques with ulceration and central hypopigmentation surrounded by hyperpigmentation. This presentation is consistent with ??? it most commonly affects sun-exposed regions of the head and neck but may also involve the chest and upper extremities. The lesions tend to slowly expand over a period of months to years, eventually leading to dermal atrophy and scarring. The rash often extends into the hair follicles, resulting in scarring alopeci

Answer 187

discoid lupus erythematosus (DLE)

Question 188

??? is characterized by scaly papules or plaques with sandpaper-like texture on sun-exposed areas (eg, face, scalp). Lesions are precursors to squamous cell carcinoma and are treated with cryotherapy or topical agents (eg, 5-fluorouracil), depending on distribution.

Answer 188

Actinic keratosis

Question 189

??? causes acute, diffuse, noninflammatory hair loss. It is often triggered by a stressful event, such as weight loss, pregnancy, major illness or surgery, or psychiatric trauma. Patients have widespread thinning of hair but the scalp and hair shafts appear normal. It is a self-limited disorder but may take up to a year to resolve completely. In the hair pull test, small tracts of hair (50-60 fibers) are pulled firmly; extraction of >10%-15% of fibers is abnormal and suggests

Answer 189

Telogen effluvium

Question 190

skin biopsy in Dermatitis herpetiformis shows subepidermal microabscesses (blisters) at the tips of the dermal papillae; immunofluorescence studies show deposits of anti-epidermal transglutaminase IgA in the dermis. Initial treatment includes ???, which has anti-inflammatory and immunomodulatory properties and provides rapid relief of symptoms. Long-term management requires a gluten-free diet.

Answer 190

dapsone

Question 191

A nonhealing ulcer arising from a chronic wound or scar is concerning for ??

Answer 191

squamous cell carcinoma

these neoplasms tend to be aggressive, with a high risk for recurrence, local invasion, and metastasis. Timely diagnosis with biopsy is required.

Question 192

?? typically affects patients age 40-60. Lesions are characterized by painful, flaccid bullae that easily rupture to form erosions, which may be the only lesions at the time of presentation. Mucosal surfaces are almost always affected, with the oral mucosa being the most common initial site of involvement, as in this patient. Cutaneous lesions typically follow and arise from a background of normal-appearing or erythematous skin

Answer 192

pemphigus vulgaris (PV), a life-threatening autoimmune blistering disease that results from a loss of cohesion between epidermal cells.

Question 193

Mild facial flushing and sensitivity due to rosacea can often be managed with simple behavioral measures (eg, avoidance of sun exposure, hot/spicy foods, or alcohol). However, patients with papulopustular rosacea (ie, papules and pustules on the central face) typically require pharmacologic treatment. First-line options include topical ???

Answer 193

metronidazole, azelaic acid, and ivermectin.

Question 194

??? is a benign nodule containing squamous epithelium that produces keratin. It presents as a dome-shaped, firm, freely movable cyst or nodule with a small central punctum. The lesion can remain stable or gradually increase in size but may produce a cheesy white discharge; it usually resolves spontaneously.

Answer 194

Epidermal inclusion cyst

vs. lipoma which is SOFT/rubbery, and does not regress
vs. dernatofibroma which has a dimpling in the center/”button-hole”

Question 195

Absolute contraindications to combination hormonal contraceptives include a history of antiphospholipid antibody syndrome or thromboembolism. Patients with these conditions should be placed on hormone-free contraceptives, particulary ?

Answer 195

copper intrauterine device

Question 196

Otitis media with effusion (OME) is defined by middle ear fluid without tympanic membrane (TM) inflammation (eg, bulging, erythema). Examination shows air-fluid levels and poor TM mobility. Management is ???

Answer 196

observation with follow-up for resolution because chronic OME is associated with speech delay and long-term hearing loss

Question 197

? is warranted for chronic otitis media with effusion with associated hearing loss

Answer 197

Tympanostomy tube placement is warranted for chronic OME with associated hearing loss

Question 198

newborn has cyanosis with feeding (ie, mouth occlusion) that is relieved by crying, findings suggestive of ???. This congenital malformation is caused by failure of the posterior nasal passage to canalize completely, leaving a bony or membranous obstruction.

Answer 198

choanal atresia

It may occur in isolation or as part of the CHARGE syndrome (coloboma [missing eye tissue], heart defects, atresia choanae, growth retardation, genital abnormalities, and ear abnormalities

Question 199

???is the most common cause of nonhereditary sensorineural hearing loss in children.

Answer 199

Congenital cytomegalovirus infection

the infection is frequently asymptomatic in infants but can cause progressive or delayed-onset, unilateral or bilateral hearing loss later in childhood.

Question 200

Chronic suppurative otitis media is often preceded by an episode of acute otitis media and is defined as chronic (>6 weeks), purulent otorrhea with tympanic membrane perforation. Treatment is an ototopical fluoroquinolone to target the most common pathogens ???

Answer 200

Staphylococcus aureus and Pseudomonas aeruginosa

Question 201

After securing the airway in patients with epiglottitis, initial treatment consists of which abx?

Answer 201

broad-spectrum antibiotic therapy with ceftriaxone (targeting Haemophilus influenzae and Streptococcus species) and vancomycin (targeting Staphylococcus aureus).

Question 202

In children, a midline, cystic neck mass that moves with swallowing is likely a thyroglossal duct cyst. A thyroglossal duct cyst forms from retained epithelium from the embryologic descent of the thyroid gland.

tx?

Answer 202

surgical removal

and imaging for thyroid tissue

Question 203

??? is characterized by progressive fever and (often unilateral) pharyngeal pain; examination findings include trismus, muffled voice, and swelling of the soft palate with uvular deviation.

Answer 203

Peritonsillar abscess

Abscesses with a classic presentation can usually be diagnosed clinically. Treatment involves needle aspiration or incision and drainage plus antibiotic therapy.

Question 204

??? is a benign growth of the squamous epithelium and accumulation of keratin debris within the middle ear. Most cases are acquired (not congenital) and unilateral. Risk factors include a history of recurrent acute otitis media (AOM), chronic middle ear effusion, and tympanostomy tube placement. Examination reveals a pearly white mass, most commonly in the anterosuperior quadrant of the TM, or a visible retraction pocket with draining debris. Treatment is surgical excision.

Answer 204

Cholesteatoma

Question 205

Symptoms of orbital cellulitis include proptosis, ophthalmoplegia, and visual changes. ??? is the most common predisposing factor for orbital cellulitis.

Answer 205

Bacterial sinusitis

Question 206

Strabismus, or ocular misalignment, can be detected by asymmetric red and corneal light reflexes as well as eye deviation on cover test. Management includes correction of refractive errors and strengthening the affected eye by ???

Answer 206

patching or applying drops to blur vision in the normal eye. Without treatment, strabismus can lead to amblyopia, a functional reduction in visual acuity of the deviated eye

Question 207

patient has chronic enteroviral meningitis, recurrent pneumonia, and also chronic diarrhea (Giardia) which are features of ????

Answer 207

X-linked agammaglobulinemia (XLA)

Question 208

symptoms include bilateral ocular pruritus, conjunctival injection, and eyelid edema. Patients often have clear discharge and mild crusting, but no purulent discharge, visual changes, or pain.

Answer 208

Allergic conjunctivitis (AC) caused by IgE-mediated acute hypersensitivity to environmental allergens.

Question 209

Leukocoria, or white pupillary reflex, in an infant or young child should prompt immediate referral to an ophthalmologist to evaluate for ???

Answer 209

retinoblastoma

Question 210

?? is usually triggered by antibiotic therapy (eg, penicillin, sulfa drugs). It typically occurs in children 5-14 days after medication initiation and presents with low-grade fever, urticarial rash, and arthralgia. Manifestations resolve completely as the medication is metabolized over days.

Answer 210

Serum sickness–like reaction

Question 211

??? most commonly presents with a mild papular or nodular skin lesion and ipsilateral lymphadenitis of gradual onset. These symptoms in the setting of cat exposure are sufficient to make a clinical diagnosis

Answer 211

Cat-scratch disease, caused by Bartonella henselae

Question 212

postexposure prophylaxis for all household contacts to bortadella pertussis regardless of vaccination status?

Answer 212

macrolide (ery, azi)

Question 213

seizures in the setting of acute bacterial gastroenteritis should raise concern for ?? infection. Bug is transmitted by ingestion of contaminated food or water and is sometimes implicated in outbreaks in community settings (eg, day care facilities) due to the low infectious dose required for person-to-person spread.

Answer 213

Shigella

Question 214

??? is the most common gastroenteritis in the United States and is often implicated in outbreaks on cruise ships and in schools. Patients develop vomiting, watery diarrhea, and abdominal pain 1-2 days after exposure. Treatment is supportive, and symptoms generally resolve within 2-3 days

Answer 214

Norovirus

Question 215

norovirus vs. rotavirus

Answer 215

rotavirus occurs in unvaccinated children <2

norovirus is more common, among all age groups

Question 216

??? are the most common bacterial causes of acute bacterial rhinosinusitis, which commonly presents with ≥10 days of persistent nasal discharge and cough.

Answer 216

Nontypeable Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis

Question 217

??? and presents with fever, pharyngitis, circumoral pallor, strawberry tongue, and rash. The classic “sandpaper” rash is prominent along skin folds (eg, axillae, groin) and often results in desquamation.

Answer 217

Scarlet fever is caused by group A Streptococcus (S pyogenes)

Question 218

This newborn’s low birth weight due to fetal growth restriction, microcephaly, ventricular septal defect, and closed fists with overlapping fingers are all classic physical examination features seen in ??? Other findings include micrognathia, prominent occiput, rocker-bottom feet, and severe intellectual disability.

Answer 218

trisomy 18 (Edwards syndrome).

Question 219

Characteristic features of Prader-Willi syndrome include hypotonia, hyperphagia, and obesity. Genetic testing confirms the loss of expression of a critical region in the paternal copy of the ???

Answer 219

long arm of chromosome 15.

Question 220

Child’s hyperphagia, obesity, and poor muscle tone are characteristic of ??? Behavioral difficulties, often seen in relation to food seeking (such as hitting in this case), as well as developmental delays are common. Poor sucking in infancy is followed by the development of hyperphagia from age 1 to 6.

Answer 220

Prader-Willi syndrome (PWS),

Question 221

Kallmann syndrome is a disorder of ??? that results in delayed puberty (ie, primary amenorrhea) and anosmia. Due to the lack of GnRH secretion, patients have hypogonadotropic hypogonadism (low FSH). In these patients, karyotype (genotype) is consistent with phenotype.

Answer 221

migration of fetal GnRH and olfactory neurons

Question 222

Characteristic features of Turner syndrome include webbed neck, horseshoe kidney, and nail dysplasia. ??? occurs due to dysgenesis of the lymphatic system and presents at birth with nonpitting carpal and pedal edema.

Answer 222

Congenital lymphedema

Question 223

??? syndrome is characterized by peripheral precocious puberty, irregular café-au-lait macules, and polyostotic fibrous dysplasia (eg, recurrent fractures).

Answer 223

McCune-Albright

Question 224

choanal atresia (cyanosis during feeding) can be part of what constellation

Answer 224

CHARGE syndrome is often identified clinically in the newborn period and is characterized by the following features: Coloboma, Heart defects, Atresia choanae, Retardation of growth, and Genitourinary and Ear abnormalities.

Question 225

Short stature, amenorrhea, and aortic coarctation are features of Turner syndrome. Patients are at increased risk of ??? due to estrogen deficiency from ovarian dysgenesis

Answer 225

osteoporotic fracture

Question 226

?? classically presents as progressive gait ataxia and dysarthria in adolescents or young adults. Neurologic manifestations (eg, ataxia, dysarthria, loss of vibration/position sense) result from degeneration of the spinal tracts (ie, spinocerebellar tracts, posterior columns). Other clinical features include hypertrophic cardiomyopathy, diabetes mellitus, and skeletal deformities (eg, scoliosis).

Answer 226

Friedreich ataxia

Question 227

Friedreich ataxia is a neurodegenerative disorder that classically presents in adolescence with progressive ataxia and dysarthria. The most common cause of death is ???

Answer 227

cardiac dysfunction (eg, arrhythmia, congestive heart failure) due to hypertrophic cardiomyopathy.

Question 228

Patients with acute ??? poisoning have abdominal pain, diarrhea, and hematemesis; in addition, they may develop hypovolemic shock within a few hours due to gastrointestinal losses. Laboratory evaluation reveals an anion gap metabolic acidosis, and x-ray may show radiopaque tablets.

Answer 228

iron

Question 229

occurs in children age <1 after exposure: constipation, irritability, oculobulbar weakness (eg, absent gag reflex, ptosis), hyporeflexia, progressive hypotonia, and eventual paralysis.

Answer 229

Infant botulism

Question 230

??? presents with cyanosis after exposure to an oxidizing agent (eg, dapsone, nitrites, anesthetics). Pulse oximetry saturation is typically low and does not improve with the administration of oxygen; however, PaO2 is normal

Answer 230

Methemoglobinemia

Question 231

?? is a common finding in neonates with Down syndrome. Additional features of Down syndrome in newborns include upslanting palpebral fissures, a protruding tongue, and a single palmar crease.

Answer 231

Hypotonia including poor muscle tone and a weak suck are key findings.

Question 232

Severe hypospadias is characterized by a urethral meatus located at the perineum or scrotum, an underdeveloped penis/glans, and severe penile curvature. This condition may be indicative of a disorder of sex development and warrants what tests???

Answer 232

karyotype analysis and pelvic ultrasound

Question 233

??? (ie, inflammation of the glans penis) is common in uncircumcised toddlers and preschoolers due to poor genital hygiene. Candida albicans infection should be considered when thick, white discharge is present, and budding yeast on potassium hydroxide microscopy confirms the diagnosis. Treatment includes proper hygiene and a topical antifungal

Answer 233

Balanitis

Question 234

Hypospadias is characterized by a ventrally displaced urethral opening and dorsal hooded foreskin. ??? is required prior to circumcision because the foreskin may be needed for hypospadias repair, and conventional circumcision techniques may be unsafe.

Answer 234

Urologic evaluation

Question 235

Unilateral cryptorchidism can be monitored until age 6 months, after which spontaneous descent is unlikely. In such a case, orchiopexy is indicated before age ? to reduce the risk of testicular torsion, infertility, and testicular malignancy.

Answer 235

1

Question 236

??? should be suspected in a patient with cryptorchidism and an acute abdomen. Infants may have irritability, inconsolable crying, and pain with abdominal palpation.

Answer 236

Intraabdominal testicular torsion

Question 237

??? is the most common cause of bacterial pneumonia in young children with cystic fibrosis, especially in those with coexisting influenza infection.

Answer 237

Staphylococcus aureus

Question 238

For patients with severe pneumonia, frequent hospitalizations, or recurrent skin infections, intravenous ??? should be included for empiric therapy against methicillin-resistant S aureus.

**Especially for cystic fibrosis patients

Answer 238

vancomycin

Question 239

what is this finding in a child <3

Answer 239

A large thymic silhouette is a normal finding on frontal chest x-ray in children age <3 because it is relatively large compared to the small thorax. The thymus normally atrophies after puberty. Therefore, opacities in this location in adults raise concern for a pathologic cause (eg, lymphoma, germ cell tumor).

Question 240

??? should be suspected in an enterally fed, premature or very-low-birth-weight infant with nonspecific apnea, lethargy, and abdominal distension.

Premature (especially gestational age <32 weeks) and very-low-birth-weight neonates receiving enteral feeds, particularly with formula, are at greatest risk

Answer 240

Necrotizing enterocolitis

Question 241

neonate with increased work of breathing and cyanosis immediately after birth most likely has ???, a condition that occurs predominantly in premature neonates ​​​​​​​

Answer 241

neonatal respiratory distress syndrome (RDS)

Question 242

Neonatal respiratory distress syndrome is caused by ??? leading to increased alveolar surface tension and atelectasis. Areas of the lung that are perfused but not ventilated (ie, ventilation/perfusion mismatch) lead to intrapulmonary right-to-left shunting and hypoxia.

Answer 242

surfactant deficiency

Question 243

In neonatal respiratory distress syndrome the areas of collapsed lung are perfused but not ventilated (ie, ventilation/perfusion mismatch), with resultant ???, leading to deoxygenated blood being delivered to the left side of the heart and to systemic circulation.

Answer 243

intrapulmonary right-to-left shunting

Question 244

??? is a chronic complication of prematurity caused by the arrest of pulmonary development and characterized by a prolonged oxygen requirement. Histologic findings include a decreased number and septation of alveoli.

Answer 244

Bronchopulmonary dysplasia

Question 245

Hemolytic uremic syndrome (HUS) is characterized by the triad of hemolytic anemia, thrombocytopenia, and acute kidney injury (typically following a prodromal diarrheal illness caused by Escherichia coli O157:H7). The mechanism of intrinsic renal injury in HUS is???

Answer 245

renal vascular occlusion caused by capillary microthrombi; also causes hemolytic anemia due to shredding by microthrombi

Question 246

patient has normocytic anemia, thrombocytopenia, and edema following a diarrheal illness, findings that are suggestive of ???

Answer 246

hemolytic uremic syndrome (HUS)

Question 247

Hydroxyurea reduces complications of sickle cell disease by increasing fetal hemoglobin production and reducing production of hemoglobin S. Hydroxyurea also causes ??? and myelosuppression due to inhibition of ribonucleotide reductase.

Answer 247

macrocytosis

Question 248

??? is a childhood malignancy derived from primitive sympathetic ganglia and may arise anywhere along the sympathetic chain or within the adrenal medulla. Most cases are diagnosed at age <2, and classic presentation includes a palpable abdominal mass with systemic symptoms (eg, fever, weight loss).

Answer 248

Neuroblastoma

Question 249

features of this malignancy include periorbital ecchymoses (“raccoon eyes”), which are caused by orbital metastases that obstruct palpebral blood vessels. Opsoclonus, or rapid eye movements, is a rare autoimmune paraneoplastic finding that may present in conjunction with myoclonus, or rhythmic jerking of the trunk or extremities, and is called opsoclonus-myoclonus syndrome

Answer 249

Neuroblastoma

Question 250

??? often presents with bruising, petechiae, and bleeding due to impaired platelet production in the bone marrow. Other common findings are nontender lymphadenopathy and hepatosplenomegaly.

Answer 250

Acute lymphoblastic leukemia

Question 251

??? should be considered in an adolescent patient with an anterior mediastinal mass in addition to pancytopenia, hepatosplenomegaly, and testicular enlargement. Presentation often relates to compression of mediastinal structures, such as superior vena cava syndrome causing jugular venous distension and difficulty breathing/cough

Answer 251

Acute lymphoblastic leukemia

Question 252

Hemophilic arthropathy is a consequence of ??? and is associated with hemosiderin deposition leading to synovitis and fibrosis within the joint. The risk of hemophilic arthropathy is reduced by prophylactic treatment with factor concentrates.

Answer 252

recurrent hemarthroses

ie with hemophilia disorders

Question 253

patient has splenomegaly and signs of hemolysis (anemia, jaundice) following an upper respiratory illness. These clinical features, along with a family history of multiple relatives requiring splenectomy, make ??? the most likely cause of his hemolytic anemia

Answer 253

hereditary spherocytosis (HS)

HS is usually due to an autosomal dominant defect in red blood cell (RBC) membrane proteins (eg, spectrin, ankyrin) that results in sphere-shaped, fragile RBCs. Due to their shape, these abnormal RBCs get trapped and destroyed in the spleen.

Question 254

Disease severity varies but typically manifests as a triad of hemolytic anemia, jaundice, and splenomegaly in hereditary spherocytosis. A key laboratory finding is elevated ??? due to cellular dehydration and membrane loss. diagnosis can be confirmed by assessing RBC fragility with either the eosin-5-maleimide (EMA) binding test (flow cytometry) or acidified glycerol lysis test.

Answer 254

mean corpuscular hemoglobin concentration (>36% Hb/cell)

Question 255

??? is the most common cause of congenital bone marrow failure and is due to defective DNA repair. In addition to pancytopenia, characteristic features include short stature, thumb anomalies, and abnormal skin pigmentation.

Answer 255

Fanconi anemia

Question 256

Patients with chronic immune thrombocytopenia have platelets <100,000/mm3 for >1 year. ?? is an option for those with persistent bleeding and thrombocytopenia despite repeated pharmacologic interventions (eg, glucocorticoids, anti-D, intravenous immunoglobulin).

Answer 256

Splenectomy

Question 257

Chronic Immune thrombocytopenia (ITP) evaluation includes bone marrow examination and blood tests for infection (eg, HIV, hepatitis C, cytomegalovirus) and autoimmune disorders (eg, systemic lupus erythematosus, thyroid disease). If laboratory evaluation is negative, management is similar to acute ITP. This includes observation alone if asymptomatic, or a combination of ??? for bleeding episodes.

Answer 257

glucocorticoids, anti-D immune globulin (if Rh-positive and Coombs-negative), and/or intravenous immunoglobulin

Question 258

A radiographic finding of gas within the wall of the intestine (pneumatosis intestinalis) confirms the suspected diagnosis. Conservative management of the condition involves parenteral nutrition and antibiotics. In the case of advanced disease and intestinal perforation, however, surgery is necessary.

Answer 258

Necrotizing enterocolitis (NEC)

Question 259

Typical presentation involves a child age 2-5 with a unilateral abdominal mass (ie, a mass that does not cross the midline). The mass is often asymptomatic; however, some patients may have associated abdominal pain or hematuria. Hypertension can also occur (as in this patient) due to renin secretion by tumor cells and/or compression of renal vasculature by the mass.

Answer 259

Wilms tumor (nephroblastoma) is the most common renal malignancy in children. It typically presents with an asymptomatic unilateral abdominal mass.

Question 260

WAGR syndrome includes: Wilms tumor, ????, Genitourinary abnormalities, mental Retardation

Answer 260

Aniridia

Aniridia is a rare condition characterized by abnormal development of the iris of the eye

Question 261

WAGR syndrome/11p deletion syndrome is characterized by a predisposition to Wilms tumor and the presence of Aniridia, Genitourinary abnormalities, and intellectual disability (previously mental Retardation). WAGR syndrome should be considered in a child with 2 or more of the associated conditions. In patients with WAGR syndrome, screening includes ??

Answer 261

abdominal ultrasound is performed every 3 months in infancy and early childhood for early detection of Wilms tumor.

Question 262

urinary tract infections in children are most commonly caused by E.coli

empiric antibiotics for suspected UTI are ????

Answer 262

third-generation cephalosporin is recommended.

Question 263

Posterior urethral valves are the most common cause of urinary tract obstruction in newborn boys. ??? from urinary obstruction can lead to Potter sequence, which is characterized by pulmonary hypoplasia, flat facies, and limb deformities.

Answer 263

Oligohydramnios

Question 264

??? is a risk factor for recurrent cystitis in young children. The impacted stool can cause rectal distension, which compresses the bladder and urethra, prevents complete voiding, and leads to urinary stasis and bladder infection

Answer 264

Chronic constipation

Question 265

Wilms tumor is the most common renal malignancy in children. Although it usually presents as an asymptomatic abdominal mass, ??? may occur in up to one-fourth of patients. Abdominal pain and hypertension may also be present.

Answer 265

hematuria

Question 266

This child has high fever (≥39 C [102.2 F]) without a source (eg, acute otitis media, bronchiolitis). Most children with fever have a viral illness, but occult bacterial infection (eg, urinary tract infection [UTI], bacteremia, pneumonia) must be considered in infants or unimmunized children due to an increased risk in these groups. The most common occult infection is a ???

Answer 266

UTI

Question 267

Immune complexes are deposited between the glomerular basement membrane (GBM) and the mesangium (ie, subepithelial), causing complement system activation and accumulation of complement component C3 within the deposits. This results in low serum C3 and CH50 levels but relatively normal C4.

most likely which Nephritis in children ?

Answer 267

Acute poststreptococcal glomerulonephritis, a complication of group A Streptococcus infection (eg, impetigo), occurs due to subepithelial deposition of streptococcal antigen/antibody immune complexes and accumulation of complement component C3 within these deposits.